Healthcare companies working in Russia need high quality communication support more than ever. The market is very high on the Russian government agenda and the sector is now witnessing an unprecedented level of scrutiny of their activities.
Since autumn 2009 FAS (Federal Anti Monopoly Service) audits have swept across the pharmaceutical industry and the Russian Government has embarked on implementing the Pharma 2020 Strategy. The Ministry of Health Care and Social Development has begun to collaborate more closely with the Ministry of Industry and Trade (especially within the pharmaceutical working group under the Presidential Modernisation Commission) to make sure the domestic pharmaceutical companies are given a clear priority when it comes to state purchases and inclusion of new drugs in reimbursement lists.
At the same time both President Medvedev and Prime Minister Putin in talking to their counterparts during bilateral negotiations in home countries of some of our foreign pharmaceutical clients express more willingness to support foreign investors in Russia, although it largely remains a general signal not really being translated into concrete supportive actions down the vertical as of yet.
All of these factors and recent developments make strategic communications critical for international healthcare companies to develop their business successfully, maintain and even strengthen their market position and share in Russia. Integrated strategic communications advice can help them better understand the specific political and regulatory environment in which they are operating that is critical to their operational success, as well as the wider target audiences of the medical community, associations and think tanks, the media and ultimately, the general public.
Successfully communicating key health concepts to governments and the general public, and changing long-held habits, requires a strong, often diverse, campaign grounded in a solid understanding of local beliefs and traditions.
Healthcare Communications: From a Medical Model to a Wellness Model
Healthcare in Russia is changing at unprecedented levels. The old ‘GP-led’ model that featured a well-known family physician providing medical treatment has been replaced by healthcare organizations and systems that promote prevention and wellness alongside treatment. Modern living requires a more visionary health system to head off expensive implications of health epidemics related to long term conditions.
For example, clinical practice is evolving, service remuneration is being re-aligned and operational structure is being changed. Secondly, management of healthcare systems is being closely aligned with information and new technology where both are in development and could be improved. Lastly, political will to change the healthcare system is strong at a time when there is less money in the economy than many would like to see.
Therefore, all these changes combine to challenge even the most astute communications practitioner.
Up until the late 1990s, the pharmaceutical industry enjoyed positive perceptions and reputational ratings. This fell fast over the years, until it touched rock bottom in 2004. Though slightly higher today, the pharmaceutical industry, the managed care industry and the health insurance industry are still among the most unpopular of all industries.
Pharmaceutical companies, especially foreign pharma corporations, have been accused by Russian authorities (both publicly and in direct communications) of manipulating healthcare professionals and selling drugs at "unjustifiably high prices" covering it up by "caring for patients" in Russia. The critique has faded somewhat of late with attention now focused on reformatting the Ministry of Health Care and Social Development but it will take long time for the pharma industry to regain trust of the federal and regional authorities in Russia.
Several recent major national and global surveys of consumers and pharmaceutical industry stakeholders, including physicians, health insurers, researchers and policy makers, have found that the public believes the pharmaceutical industry has put profits before patients, abandoning its original vision of improving human health.
As a result, the public disregards the benefits that pharmaceutical companies bring to healthcare. Therefore the communications challenge is to persuade the industry to take narrow the perception gap between its actions and public perception. Otherwise its damaged reputation will continue to pose a threat to the long-term success of the industry.
The same surveys found that, when deciding whether to use a given pharmaceutical product, consumers place more value on a pharmaceutical company's reputation than pharmaceutical executives believed.
In today’s market a healthcare communicator must walk a fine line between promoting profit and care when working with a pharmaceutical company.
What are the golden rules of communication?
In terms of communicating effectively in Russia there are several generic dos and don’ts that we have identified having worked with different layers of the Russian Government, medical and patient communities:
What to do:
• Do a competition analysis: are you a broadly market focused company with top selling drugs that could be replaced with Russian generic medicines or a focused company with a portfolio of unique products? What are your competitors’ strategies?
• Discreetly outreach to warm contacts to verify your initial ideas for anchoring in Russia, develop your strategy, package it and present to Russian authorities in a favorable political environment to get a high level principal ‘blessing’
• Liaise with credible independent state-owned organizations and experts in the industry to (directly or indirectly) endorse your campaign in the media and therefore in the eyes of public
• Establish contact and build relationships with leading editors and journalists that will carry your messages in the coverage. Develop angles that go in line with the publication’s editorial plans and priorities
• Support your media outreach with data and statistics – local and global and educate the journalists about the topic
• Build advocates in the medical community to substantiate your client or company position and advocate the product or service independently and from a medical perspective
What not to do:
• Assume that packaging your drugs in Russia will solve your problems. It may not. Although we note some commitment to high-tech packaging processes do meet ‘local manufacturing criteria’ in some Russian regions (so choice of which Russian region you select are therefore critical) This is an acutely important business planning variable
• Assume that dangling an investment project (R&D or local production or manufacturing plant) before the Russian government bodies will solve many of your market access problems. Mind you: what you think is unprecedented for your company may be already assumed by Russian authorities
• Communicate directly to government officials in a mode ‘what do you want us to do to stay in the market’. This approach will inevitably impose unwanted commitments on you.
• Continue with one dimensional communications saying ‘we always act in the interests of Russian patients’. Medical companies invariably are, of course but this message without clinical or proven evidence from Russian third parties only irritates decision makers
• Expect journalists to line up for publishing articles on the topic because ‘this is an important topic’ We have good relationships with relevant journalists, these take time and intellectual effort to maintain
Compliance and Legal Considerations: An Ethical Code of Conduct
Globally, communications ethics have become particularly relevant in the last decade following a series of high-profile lawsuits in the United States, United Kingdom and Germany covering a wide range of ethical breaches on issues concerning clinical trials, medical research, information disclosure, gifts to doctors and so on. These lawsuits have added a new dynamic to the public ethics debate on healthcare and drug/treatment provision in the United States and the EU, but with effects felt globally as well.
While basic professional guidelines and ethical codes of the public relations industry prohibit paid-articles, false statements and slander, healthcare communications goes several steps further in terms of providing a system of standards to support transparent and fact-based interaction with target audiences .
These guidelines are more stringent than the standard professional guidelines for public relations activities, and are based on international conventions, national legislation and industry association agreements such as the following:
• Guiding Government Pillars and Principles of Healthcare Communications
• Industry Self Regulating Principles
• International Federation of Pharmaceutical Manufacturers and Association’s (IFPMA) Code of Pharmaceutical Marketing Practices
• European Federation of Pharmaceutical Industries and Associations (EFPIA) Code of Practice on the Promotion of Medicines
• Directive 2001/83/EC on the community code relation to medicinal products for human use, as amended by Directive 2004/27/EC
Grey Areas in Healthcare Communications in Russia
Anti-corruption amendments to the Civil Code and federal law "On Civil Service in the Russian Federation" stipulates that any gift for government officials exceeding 3,000 RUR in value may be considered a bribe. Gifts should be presented to government officials at public events only. The law also limits or prohibits financing business trips of government officials by the business.
Unlike media and advertising, in Russia there is no clear set of laws providing specific guidance for healthcare lobbying and no specified legislated regulation how pharmaceutical companies can interact with the policy-makers, medical community and public – beyond, of course, fundamental laws on corruption, slander and libel. The government relations and public affairs realm is non-transparent on many levels, particularly when dealing with the budgetary decision-making process for drug and treatment reimbursements (‘market access’).
Overall, the pharmaceutical industry in Russia can be characterized as ‘grey’ where pharmaceutical distribution companies work outside of international compliance standards and market access can be severely restricted.
International pharmaceutical companies from the United States and the EU are still regulated in this realm by their home-country laws (FCPA, EU directives and domestic member-state national law), but can still find effective and compliant communications channels through alliance building with patient advocacy groups, industry associations, hosting conferences and roundtables, and strategic messaging to key health policy officials to create ‘win-win’ scenarios.
Russian policy-makers, to the highest-levels of the Presidency, understand the importance of both health awareness and the need for modern healthcare, and are increasingly seeking audience with international pharmaceutical companies that can make a case for how their drugs and treatments can provide both clinical and economic benefits to the Russian population as a whole.
Planning a Healthcare Communications Campaign
In planning a healthcare communications campaign, the two primary issues a pharmaceutical company needs to consider in foreign markets are:
• Access to the market itself - the ability to navigate the regulatory maze in order to have drugs licensed, and in best-case scenarios, on government reimbursement lists
• Access to ‘consumers’ - doctors and patients
While these two targets are distinct, they are both critical to achieving overall communications success. A full-spectrum campaign involves both lobbying/advocacy efforts to inform, influence or manage risk within the regulatory environment of federal and regional decision makers, and public relations efforts to raise awareness amongst the medical community and patients.
The President and the Government has announced its willingness to become friendlier towards foreign investment in Russia. This declaration has already translated into a more intensive dialogue of the Government with foreign investors, especially members of the Foreign Investment Advisory Council leading to concrete results: the migration legislation has been softened; the customs e-declaration has been introduced, etc. It is just the right moment for the international healthcare companies to initiate the dialogue with the Russian authorities around specific issues, ranging from transparency of entering DLO lists to appointing an ombudsman for foreign investors in the healthcare industry (reporting to First Vice Prime Minister Shuvalov).
It is also the right moment to intensify efforts in raising awareness about health economics in different therapeutic areas in view of the upcoming parliamentary and presidential elections (in 2011 and 2012 the focus of discussions and media attention will imminently be on increasing / optimising social spending, including healthcare).
Grayling has a unique set of health experts to help international healthcare providers, manufacturers and pharmaceutical companies to support investment with market access support, public relations and government relations communications strategy. Ultimately, our consultants can guide you through the challenges of doing business in the Russian healthcare sector and focus on the opportunities that exist for your business, while we both make a difference for Russian patients.
Inna Semenyuk is vice president of lifestyle and consumer affairs, social media and healthcare at Grayling Russia.